Rehabilitation Counseling Bulletin 1 Experiences of occupational rehabilitation Common themes, different perspectives: A systemic analysis of employer-employee experiences of occupational rehabilitation Dianna T Kenny Rehabilitation Counseling Bulletin, 1995, 39, 1, 54-77. Workers with injuries and their employers were interviewed using a semistructured protocol to elicit their perceptions about their own and each others behavior and that of other stakeholders in the process of occupational rehabilitation. Four common themes emerged from the interviews. Whereas workers with injuries focused on the perceived failure of the system to provide adequate care, employers were concerned with issues of cost containment and productivity. A process of triangulation of stakeholders occurs that results in polarization of the primary employer-employee dyad. Changes to the current system are recommended, including specific educational campaigns targeting employers and the training and accreditation of rehabilitation coordinators. INTRODUCTION The 1980s was an era of deregulation in Australia in which socially desirable ends were thought to be best achieved through the operation of market forces rather than by government intervention (Hopkins, 1994). The market approach relies on economic incentives, and its proponents in the area of occupational health and safety argued that government regulation had not adequately ensured worker health and safety. It was proposed that employers be provided with an economic incentive to minimize occupational injury and disease. In the 1980s, several state workers’ compensation authorities introduced premium incentive schemes. In New South Wales, the Workers’ Compensation Act was passed in 1987. This act not only introduced a premium incentive scheme for employers, but also provided for the occupational rehabilitation of workers with injuries. This meant that employers were obliged to establish a workplace rehabilitation program to assist their workers with injuries to return to work. This involved the appointment, either full- time or part-time, of a rehabilitation coordinator, whose function is to provide information to the worker, to establish liaison with key personnel such as the supervisor and the treating doctor, and to negotiate suitable duties. The rehabilitation coordinator may also be involved in referring to specialist occupational rehabilitation providers for assistance such as workplace modification, development of upgraded return-to-work programs, or vocational redirection. The Industrial Relations Act (1992) complemented the employer’s obligations by making it an offense to dismiss an employee who is injured within 26 weeks of the injury solely or primarily because of the injury. The Work- Cover Authority of New South Wales, a statutory self-funding body, was established in 1990 to administer the 1987 legislation. It is funded by a 4% levy on each workers’ compensation policy from every employer in New South Wales. Although there were many reported benefits of the new legislation (Kenny, 1994a), difficulties with the administration of the legislation became apparent, particularly in rural areas and for workers with long- term injuries (WorkCover Authority, 1992). These difficulties were reflected in poor return-to-work rates following occupational rehabilitation (Industry Commission, 1994) and the formation, in 1991, of the Hunter Action Group Against WorkCover. This organization, based in the Newcastle-Hunter region (a large regional city with surrounding rural areas) of New South Wales, consists of about 350 workers with injuries who have experienced difficulties with their rehabilitation and reintegration back into the workforce. Its charter is to provide advocacy for these workers to ensure that appropriate services are made available to workers with injuries in a timely and systematic way and to work toward improving the rehabilitation process. Recent analyses of injury occurrence and outcomes of injury can be categorized along two broad dimensions. These are the “victim blaming” approaches adopted by adherents of the medical model orientation to occupational injury and its management (see Davis & George, 1988) and the “system blaming” approach of many industrial sociologists (James, 1989; Quinlan & Bohie, 1991; Wiffiams & Thorpe, 1992). Neither of these approaches have attended sufficiently to the interactions between workers and systems nor have they demonstrated sufficient explanatory power for either the successes or failures of occupational rehabilitation. A third approach, namely the systemic model (Cottone & Emener, 1990), provides a possible alternative paradigm for understanding outcomes of the occupational rehabffitation process and for